Permit IN..„, ,. CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: ELC2018-00061
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 01/23/2018
T tc ;Lkt.L7 9
Parcel: 2S106DB14200
Jurisdiction: Tigard
Site address: 17435 SW FOREST HOLLOW ST
Project: River Terrace Northwest,Lot 142 Subdivision: RIVER TERRACE NORTHWEST Lot: 142
Project Description: Adding(1)branch circuit for A/C.
Contractor: GARNER ELECTRIC WASHINGTON LLC Owner: ADLV LAND HOLDINGS LLC
402 VALLEY AVE NW, SUITE 106 BY FORSUM, MICHAEL
PUYALLUP,WA 98371 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 253-872-6051 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 01/23/2018 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/23/2018 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9 2-001-0090. Youq�ay obtai a copy o he rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �� , /y Permittee Signature: 5r /� e4..
5r
INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Electrical Permit A ]licat(>tolrn
_{ ICtrt�Uf'7[Tigard
JAN 1 8 �'O 3 T b?o r>cl ti c 4� Y s
Received~ p
't 13125 SW Hall Blvd.,Tigard,OR 9722 Plate/By: Pet-mil t( l.�b� �Q�1/_l
�' g ::i Phone: 503.718.2439 Fax 503598,1Vy01 f -,+ , r` l3aPlaeReview �l
}pe dy Related Permit 8; .� e2 // ` '
1 laspeetion Line; 503.639.4175 4 1 i t t 1 ,Y :, , <
TI GARp Internet: www.tigerd-or,gov t' t easy d/Date/By: Saris: LST See Page 2 for
Notified/Method;
Supplemental Informationa, yag_ _ _ lSis : ::
;®New construction ❑Additiat/alterafion/replaeement Please check all that apply(submits sets of plans w/items checked):
❑Demolition 0 Other: ❑Service or feeder400 amps or more ❑
P Building over three stories.
<;,-r.'6;a>.e srt:,,:;�;.; .;,�„fib ,�, ;�: -- where the available fault currant
.... ..:F_. „gV,O.r.';�COI" !`RIJc ip =$•` ❑Marinas and boatyards.
s:
•-�" • -'�%�-=�i�'�•�*''':����'"�'�;��=<`'��i; "�l:��i_ exceeds 10,000 amps at 150 volts orFloatingbuildings.
®1-and 2-familydwelling0se F
0Commercial/industrial 0 Accessorybuildingless to ground,or exceeds 14,000 €
Q Commeroial-use agricultural ,:..
' • 1ampsaother installations. tis
•❑Multi-family • 0 Master builder Other: Fire pump. 0 Installation of I
50 KVA or —;,: •; : ;. _ , . d..: ,. ,.: .1 .(.. . -�.40D4TQN. ; `:rr:; .i ;`i`_ ti• :
❑Emergenoysystem. larger separately derived
Job#: Job site address/7 1��C t ❑Addition of new motor load of system.
r J � vie S IMF or more, ❑ A',•E","I_2,"1.3,
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy,
Suite/bldg./apt#: ❑Health-earefacilities. ❑Recreational vehicle parks.
I Project name:�i veer Tetra e� f1br'i`art ue i— 13 Hazardous locations, ❑Supply voltage for more than
Cross street/directions to job site: 7 ❑Service or feeder 600 amps or mora. 600 volts nominal,
•Description I Qty. ....Each• •i-• TTotal a'.:I a`.
ot
Subdivision. New residential single-or multi-family dwelling unit.
1f-OPV' Ti.APrar9_,Q'i t3rtIvi. ec4•- i Lot II: ill2. Includes attached garage.
Tax map/parcel#: d 1,000 sq,ft.or less 168.54 4
:-:,::.;;a,:F::...::.:..::::.« .S a..: .add'1500s
.._.::.,,,..n;;..-..�,wyt.',`'} .. .': ..5*44:P. 'IQNi.OiE sq.It.or portion 33.92
to
Limited energy,residential
NdSC20tl"-0001 Limited energy,multi-family
(with above sq.ft.)
7s.00 2
_z f's"i5' 2
residential above
,.t...w.:.� �JrR,....,_.;.��::,tvl::::::s.:..-.. , ., �::-• - RenewableE Energy 7 00
sq.h.)
Name:• ._... -„ .. ..2,: :>::.:.;<-..:TNaI/0iti ;,,:::,,`;.:<:;<:is;%: ❑ See Page 2 — -
(�t� Services or feeders installation,alteration,»ht1/ar relocation
`,l�) L 4(Nei.. CL,1 S r•:: 200 amps or less
100.70 2
Address: 00 �t e. _ l 201 amps to 400 amps 133,56 2
City/State/ZIP: �( (y J ,r� te ,?Cc `\ f 601 amps to 1,0 0 20034
tJ-�- 2
601 amps to 1,000 amps 301.04 2
Phone:Lc.°2./ 9�1 r 03/ Fax:( ) Over 1,000 amps or volts 552.26
yr 7 2
Small; Temporary services or feeders installation,alteration,and/or
• relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less
intended for sale,lease,rent,or exchange,according to ORS 447 449 670,and 701. 59.36 1
> > 201 amps to 400 amps 125.08
2
Owner signature:
Date:
401 ampsto 5992
"fh;3:=f' � «t •,x.t ;t.. _ .:�;;:� - .-.�• - amps 168,54
,.f.,- .r_,.. , ____ :._...: :c :4 ";" Branch circuits—
.. ;�.' :`+si F; C7`CQN`��;G'�',��'>?i2&0'N>'" i„' ,:, nefv,alteration,or extension,i er panel
Business name: With am l-Lion ::.,,+ S• A.Fee for branch circuits uee.
,� P �� above service or feeder fee, I
Contact name:�i,•`„D —�� Fee
loracircirc 7.42 2
+� C B.Fee for branch circuits without
Address: in i'1,.•r..._l.w � s `Q ,y service or feeder fee,first
JY IXJd✓t! 1G . A! branch circuit 56.18 2
City/State/ZIP:Vancouver,WA 98660 Bach add'1 branch circuit 7.42 2
Phone:(360)695-7700 I Fax;:(360)693-4442 Miscellaneous(service or feeder not included)
Each manufactured or modular
Email:'19. ! y0 �,�
dwelling,
} t p 1 t,� d g service and/or feeder 67.84 • 2
-.r
Email:
:;ac' 't*r. -; ', ,.;,o�-i�;F' DtjA4t .writ 5,, `!-j.•, Reconnectonl
'r;r:. 1>,.�:,.>;z;i ,Fs:: 3u!° ;,L : ,,.. ::: y 67.84
,.,'u._::�z”"-_r:P, � iC'l,t ' •`r: . 1 2
' '��i'�>>'i';, Q Pump or irrigation circle
Business name:Garner Electric Washington,LLC 67.84 2
Sign or outline lighting 67.84 2
Address:402 Valley Ave NW Ste 106 Signal circuit(s)or limited-energy
• panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP:Puyallup WA 98371 Each additional inspection over allowable in any of the above
Phone:(253)872-6051 Additional inspection(1 hr min) 66,25/hr
Fax:(253)872-1801 Investigation(I hr min) 90.00/hr
Email:bdaniols®gweusa,com Industrial plant(1 hr min) 78.15/hr
CCB Lie.: C1158 Inspections for which no fee is
Electrical Lie.: 208174 I Suprv.Lie.: 44965 specificaily listed(V,hrnlin) 90.00
/hr
_ "E
Suprv.Electrician signature,required: y. 7 '`;/Dt, A ' L;fi "' ,
Print name: Joan P Albert I Date: Subtotal:
❑Plan Review Required(25%of pennit fee):
State surcharge(12%of permit fee):
Authorized signature; TOTAL PERMIT FEE:
IPrint name: Bill Daniels This permit application expires if a permit is not obtained within 180
Date: days after it 1ms been accepted as complete.
I:lBuildinglpamihs PumllApp IILR nRE.doc Rev 06/17/2015 * Number of inspections allowed per permit,
410.46 i$T(11/05ICOt,USvtB